Individual provider Active NPI

Marilyn B Deluera, LCSW

  • Mental Health Counselor
  • Port Orange, FL
National Provider Identifier
1386984680
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Practice address
4770 S Ridgewood Ave
Port Orange, FL 32127-4544
Phone
(386) 425-3900
Fax
(386) 274-4140
NPI assigned
Feb 22, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X LCSW 9846
Clinical Social Worker 1041C0700X
Mental Health Counselor 101YM0800X Primary

Addresses

Primary practice location

4770 S Ridgewood Ave
Port Orange, FL 32127-4544

Mailing address

4770 S Ridgewood Ave
Port Orange, FL 32127-4544
Phone (864) 169-7673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210625001278 FL Practitioner - Clinical Social Worker 3274934401 Practice locations: Port Orange, FL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4770 S Ridgewood Ave
Suite 2
Port Orange, FL 32127-4543
Phone (386) 401-9474

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Insightful Therapeutic Solutions LLC Mental Health PastSince Aug 1, 2020 Accepting new patients
Edward Merkle Mental Health PastSince Jan 1, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741046400000",
    "number": "1386984680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 S RIDGEWOOD AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274544",
            "telephone_number": "864-169-7673",
            "fax_number": "386-274-4140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 S RIDGEWOOD AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274544",
            "telephone_number": "386-425-3900",
            "fax_number": "386-274-4140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELUERA",
        "first_name": "MARILYN",
        "middle_name": "B",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-22",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": "LCSW 9846",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

Verify at the official NPI Registry.